The Prevalence and Impact of Hepatic Steatosis on Response to Direct-Acting Antiviral Therapy in HIV–HCV Coinfection

Abstract

(1) Background: Direct-acting antiviral therapy for chronic hepatitis C virus (HCV) infection is associated with high sustained virologic response (SVR) and overcomes negative predictive factors, including steatosis, in patients without human immunodeficiency virus (HIV) coinfection. The impact of steatosis on SVR in patients with HIV–HCV coinfection is unknown. (2) Methods: A retrospective analysis of patients treated with direct-acting antivirals was performed. Demographic, laboratory and direct-acting antiviral regimen data were prospectively collected. Metabolic syndrome and its components—diabetes mellitus, hypertension, dyslipidemia and obesity—were assessed. Hepatic steatosis (≥5%) was defined by liver biopsy or controlled attenuation parameter (CAP) measurement during vibration-controlled transient elastography (VCTE). (3) Results: A total of 151 HIV–HCV-coinfected patients on combined antiretroviral therapy and direct-acting antiviral therapy were included in this analysis. Prevalence of steatosis by liver biopsy (n = 34) or CAP (≥263 db/m) during VCTE (n = 92) was 27% and was independently associated with obesity (OR 3.11; 95% CI 1.43–6.82; p = 0.004) and the metabolic syndrome (OR 1.08; 95% CI 1.01–0.15; p = 0.01). The overall SVR rate (n = 148) was 95% and was not impacted by the presence of steatosis (p = 0.42). (4) Conclusions: Hepatic steatosis is common in HIV–HCV coinfection, correlates with obesity and the metabolic syndrome and does not impact SVR.

Review article: Hepatic steatosis and its associations with acute and chronic liver diseases

“…The presence of hepatic steatosis does not appear to affect high rates of achievement of virologic cure (sustained virological response at 12 weeks after end of treatment or SVR12) with the new direct-acting antiviral agents (DAAs). 220 The burden of SLD among HCV patients increased during treatment with DAAs, despite achievement of virologic cure, in a recent real-world cohort study by Trifan et al, 221 and those with SLD were observed to have a higher burden of advanced fibrosis. Additional prospective data on outcomes of persistent and new-onset SLD after SVR12 are needed to determine need for special screening and follow-up in this population.…”

“…have reported results of a serial biopsy study with a mean follow‐up period of 6.5 years demonstrating that an initial finding of hepatic steatosis predicts increased stage of fibrosis and degree of inflammation at baseline but not their progression. The presence of hepatic steatosis does not appear to affect high rates of achievement of virologic cure (sustained virological response at 12 weeks after end of treatment or SVR12) with the new direct‐acting antiviral agents (DAAs) 220 . The burden of SLD among HCV patients increased during treatment with DAAs, despite achievement of virologic cure, in a recent real‐world cohort study by Trifan et al., 221 and those with SLD were observed to have a higher burden of advanced fibrosis.…”